About exanthema subitum in children

V.S. Androukh

Abstract

The article describes etiopathogenesis, clinical picture, diagnosis, management and prognosis of exanthema subitum (ES). The disease occurs in nearly all infants and is not well-known in the general medical community. Exanthema subitum in children, mostly aged 6 months to 2 years, is caused by herpes viruses (HSV-6, HSV-7), which are aerosol-transmissible and communicable, and is characterized by hyperthermiс syndrome and rash. Hyperthermic syndrome (≥ 39 °C) lasts for about 3 days. On day 4 of disease, body temperature normalizes, but blotchy rash appears, mainly on the trunk. It also lasts for 3 days, sometimes resulting in erythema. The disease must be differentiated with other states, from tooth eruption in a child and to the onset of acute meningococcal infection. Fever of unknown etiology, rubella, measles, scarlet fever, fifth disease, enteroviral enantemа, toxemia and allergic rashes, pneumonia, pyelonephritis, otitis media my have the same manifestations as ES. There are a number of laboratory methods for verifying the disease, but enzyme-linked immunosorbent assay and reverse transcription polymerase chain reaction are being used most often. For the treatment in febrile period, non-steroidal anti-inflammatory drugs should be administered. Symptomatic treatment is also indicated. There are few clinical data on the use of antiviral drugs such as ganciclovir, foscarnet, cidofovir, their effectiveness is controversial. The main criteria for the diagnosis of ES are: age from 6 months to 2 years; sudden onset with fever ≥ 39 °C or higher during 3–4 days at a relatively satisfactory general condition; the appearance of exanthema from the 4th day of illness, mostly on the trunk, against the normalization of body temperature; in most cases has a favorable course and does not require special treatment. However, it may be a mask of other, much more serious diseases and complications, and therefore requires careful medical supervision of a sick child.